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For some opioid overdose survivors, stigma from clinicians hinders recovery
SAN DIEGO – After an opioid-related overdose, intentions to reduce opioid use or injection are often complicated by unmanaged withdrawal symptoms and perceptions of disrespect from first responders and/or hospital staff, results from a small, exploratory study suggest.
“The opportunity for getting someone out of an overdose experience and into harm reduction, medication-assisted treatment, whatever it may be, is great,” lead study author Luther C. Elliott, PhD, said in an interview at the annual meeting of the College on Problems of Drug Dependence. “But the stigmatizing experiences of survivors tend to lead them in a beeline out of the emergency department.”
In an effort to better understand the impacts of nonfatal overdose on subsequent substance abuse patterns and overdose risk behaviors, Alex S. Bennett, PhD, Dr. Elliott, and Brett Wolfson-Stofko, PhD, interviewed 20 recent overdose survivors about their experiences. All study participants had been administered naloxone by a professional first responder and taken to an emergency department via ambulance. Next, the researchers juxtaposed their narratives with perspectives from nine emergency medical technicians (EMTs), six emergency department staff members, and six medical staff members.
“Each stakeholder was asked about their experiences with opioid-involved overdose and about the potential for staging effective interventions with persons who have been recently reversed,” explained Dr. Elliott, a medical anthropologist at the New York City–based National Development and Research Institutes.
The researchers found that 67% of EMT/emergency medical services (EMS) personnel had a history of discussing opioid-related overdose or need for treatment, while 57% had self-reported fatigue or burnout with opioid-related overdose patients. For example, one EMT/EMS study participant described responding to overdose calls as taxing. “It takes away from what I would call real patients. …When I hear you took this drug by yourself and I have to go save [you], how is that fair?”
All nine emergency medicine physicians queried had a history of intervening and self-reported fatigue or burnout with opioid-related overdose patients. One physician response was as follows: “If I’m going to see the same person over and over again, I’ve tried my best to help you and you go back to the same thing over and over again, at some point, I’m not going to have any compassion.”
Of the 20 survivors, 30% indicated no reported change in their behavioral disposition after the overdose, 10% reported delayed change, and 60% reported immediate change. Barriers to change, expressed by some of the survivors, included receiving higher doses of naloxone than necessary to reverse an opioid-related overdose, and perceived disrespect from emergency department staff. For example, one survivor contended that hospital staff “left me in the hallway. I kept asking for water and they’re like, ‘We have none.’ They brought me some ice chips finally to shut me up, because I kept trying to walk out.”
Dr. Elliott said he was surprised to learn how much EMS staff and emergency medicine physicians attempted informal interventions by just talking with survivors. “They’ve used a combination of shaming techniques, like, ‘Do you realize you almost died? You’ve got to stop using drugs.’ The stigmatizing attitudes combined with the willingness and the desire to intervene were most surprising to me.
In their abstract, he and his associates wrote that providing stakeholders “with even a brief general introduction to psychosocial interventions and sample scripts of supportive, motivational, and nonstigmatizing conversations between caregivers and the people experiencing opioid dependency may represent a positive advance in this direction.”
The study was funded by the National Institute on Drug Abuse. The authors reported having no financial disclosures and said the study content is solely their responsibility – and does not necessarily represent the official views of the National Institutes of Health.
SAN DIEGO – After an opioid-related overdose, intentions to reduce opioid use or injection are often complicated by unmanaged withdrawal symptoms and perceptions of disrespect from first responders and/or hospital staff, results from a small, exploratory study suggest.
“The opportunity for getting someone out of an overdose experience and into harm reduction, medication-assisted treatment, whatever it may be, is great,” lead study author Luther C. Elliott, PhD, said in an interview at the annual meeting of the College on Problems of Drug Dependence. “But the stigmatizing experiences of survivors tend to lead them in a beeline out of the emergency department.”
In an effort to better understand the impacts of nonfatal overdose on subsequent substance abuse patterns and overdose risk behaviors, Alex S. Bennett, PhD, Dr. Elliott, and Brett Wolfson-Stofko, PhD, interviewed 20 recent overdose survivors about their experiences. All study participants had been administered naloxone by a professional first responder and taken to an emergency department via ambulance. Next, the researchers juxtaposed their narratives with perspectives from nine emergency medical technicians (EMTs), six emergency department staff members, and six medical staff members.
“Each stakeholder was asked about their experiences with opioid-involved overdose and about the potential for staging effective interventions with persons who have been recently reversed,” explained Dr. Elliott, a medical anthropologist at the New York City–based National Development and Research Institutes.
The researchers found that 67% of EMT/emergency medical services (EMS) personnel had a history of discussing opioid-related overdose or need for treatment, while 57% had self-reported fatigue or burnout with opioid-related overdose patients. For example, one EMT/EMS study participant described responding to overdose calls as taxing. “It takes away from what I would call real patients. …When I hear you took this drug by yourself and I have to go save [you], how is that fair?”
All nine emergency medicine physicians queried had a history of intervening and self-reported fatigue or burnout with opioid-related overdose patients. One physician response was as follows: “If I’m going to see the same person over and over again, I’ve tried my best to help you and you go back to the same thing over and over again, at some point, I’m not going to have any compassion.”
Of the 20 survivors, 30% indicated no reported change in their behavioral disposition after the overdose, 10% reported delayed change, and 60% reported immediate change. Barriers to change, expressed by some of the survivors, included receiving higher doses of naloxone than necessary to reverse an opioid-related overdose, and perceived disrespect from emergency department staff. For example, one survivor contended that hospital staff “left me in the hallway. I kept asking for water and they’re like, ‘We have none.’ They brought me some ice chips finally to shut me up, because I kept trying to walk out.”
Dr. Elliott said he was surprised to learn how much EMS staff and emergency medicine physicians attempted informal interventions by just talking with survivors. “They’ve used a combination of shaming techniques, like, ‘Do you realize you almost died? You’ve got to stop using drugs.’ The stigmatizing attitudes combined with the willingness and the desire to intervene were most surprising to me.
In their abstract, he and his associates wrote that providing stakeholders “with even a brief general introduction to psychosocial interventions and sample scripts of supportive, motivational, and nonstigmatizing conversations between caregivers and the people experiencing opioid dependency may represent a positive advance in this direction.”
The study was funded by the National Institute on Drug Abuse. The authors reported having no financial disclosures and said the study content is solely their responsibility – and does not necessarily represent the official views of the National Institutes of Health.
SAN DIEGO – After an opioid-related overdose, intentions to reduce opioid use or injection are often complicated by unmanaged withdrawal symptoms and perceptions of disrespect from first responders and/or hospital staff, results from a small, exploratory study suggest.
“The opportunity for getting someone out of an overdose experience and into harm reduction, medication-assisted treatment, whatever it may be, is great,” lead study author Luther C. Elliott, PhD, said in an interview at the annual meeting of the College on Problems of Drug Dependence. “But the stigmatizing experiences of survivors tend to lead them in a beeline out of the emergency department.”
In an effort to better understand the impacts of nonfatal overdose on subsequent substance abuse patterns and overdose risk behaviors, Alex S. Bennett, PhD, Dr. Elliott, and Brett Wolfson-Stofko, PhD, interviewed 20 recent overdose survivors about their experiences. All study participants had been administered naloxone by a professional first responder and taken to an emergency department via ambulance. Next, the researchers juxtaposed their narratives with perspectives from nine emergency medical technicians (EMTs), six emergency department staff members, and six medical staff members.
“Each stakeholder was asked about their experiences with opioid-involved overdose and about the potential for staging effective interventions with persons who have been recently reversed,” explained Dr. Elliott, a medical anthropologist at the New York City–based National Development and Research Institutes.
The researchers found that 67% of EMT/emergency medical services (EMS) personnel had a history of discussing opioid-related overdose or need for treatment, while 57% had self-reported fatigue or burnout with opioid-related overdose patients. For example, one EMT/EMS study participant described responding to overdose calls as taxing. “It takes away from what I would call real patients. …When I hear you took this drug by yourself and I have to go save [you], how is that fair?”
All nine emergency medicine physicians queried had a history of intervening and self-reported fatigue or burnout with opioid-related overdose patients. One physician response was as follows: “If I’m going to see the same person over and over again, I’ve tried my best to help you and you go back to the same thing over and over again, at some point, I’m not going to have any compassion.”
Of the 20 survivors, 30% indicated no reported change in their behavioral disposition after the overdose, 10% reported delayed change, and 60% reported immediate change. Barriers to change, expressed by some of the survivors, included receiving higher doses of naloxone than necessary to reverse an opioid-related overdose, and perceived disrespect from emergency department staff. For example, one survivor contended that hospital staff “left me in the hallway. I kept asking for water and they’re like, ‘We have none.’ They brought me some ice chips finally to shut me up, because I kept trying to walk out.”
Dr. Elliott said he was surprised to learn how much EMS staff and emergency medicine physicians attempted informal interventions by just talking with survivors. “They’ve used a combination of shaming techniques, like, ‘Do you realize you almost died? You’ve got to stop using drugs.’ The stigmatizing attitudes combined with the willingness and the desire to intervene were most surprising to me.
In their abstract, he and his associates wrote that providing stakeholders “with even a brief general introduction to psychosocial interventions and sample scripts of supportive, motivational, and nonstigmatizing conversations between caregivers and the people experiencing opioid dependency may represent a positive advance in this direction.”
The study was funded by the National Institute on Drug Abuse. The authors reported having no financial disclosures and said the study content is solely their responsibility – and does not necessarily represent the official views of the National Institutes of Health.
AT CPDD 2018
Key clinical point: The majority of emergency medical services personnel and emergency department physicians indicated a history of attempting to discuss positive health change with overdose survivors.
Major finding: Of the 20 survivors interviewed, 30% indicated no reported change in their behavioral disposition after the overdose, 10% reported delayed change, and 60% reported immediate change.
Study details: An exploratory study of 20 opioid overdose survivors who were interviewed about their experiences.
Disclosures: The study was funded by the National Institute on Drug Abuse. The authors reported having no financial disclosures.
Social networks may influence youth who transition to injection drug use
SAN DIEGO – Youth and young adults who have transitioned from prescription drug misuse to injection drug use tend to reside in dense social networks, results from a novel study suggest.
“A lot of what we know about the transition from prescription opioids to drug use is from populations that have already transitioned to injection drug use, and we’re asking them retrospectively to tell us about their use,” lead study author Alia Al-Tayyib, PhD, said in an interview at the annual meeting of the College on Problems of Drug Dependence.
In an effort to examine the transition from prescription opioid misuse to injection drug use from a social network perspective, Dr. Al-Tayyib and her associates recruited Denver area residents aged 15-24 years to participate in the Social Networks of Abused Prescription Pills in Youth study between October 2015 and April 2017. Participants were recruited via direct outreach and respondent-driven sampling, which is a peer-referral sampling methodology. Individuals were eligible to participate if they were currently misusing prescription opioids or were currently using heroin after a period of prescription opioid misuse.
Study participants completed interviewer-administered behavioral and social network surveys. People from whom data were collected were referred to as “egos,” and they provided information on people in their social networks called “alters.” As a social network prompt, for example, study participants were asked to “think about people you have contact with who have been involved in your life in a significant way during the past month.”
Participants also were asked about places of aggregation with the prompt, “Where does [this person] hang out?” The egos, alters, and locations are all considered “nodes” in the social network. To examine implications on transition, the researchers examined k-plexes, or subgroups of connected nodes.
Dr. Al-Tayyib, an associate research scientist at Denver Public Health, presented results from 80 ego participants and 489 alters. The mean age of ego participants was 21.4 years, 73% were male, 68% were non-Hispanic white, and 60% reported being homeless in the past 12 months. More than three-quarters of ego participants (80%) reported injection drug use, 14% reported misusing prescription opioids, and 6% reported using heroin without injecting. Of the 489 alters, 45.2% reportedly injected, 5.9% used heroin, and 8.6% misused prescription opioids with at least one of the ego participants.
The researchers observed that study participants who transitioned to injection drug use resided in denser social network regions. “It was really hard to capture people who had not already transitioned to injection drug use, partly because that’s not a behavior that’s easily identifiable,” Dr. Al-Tayyib said. “This study is a one look in time, so it’s hard to know which came first: the chicken or the egg. If I’m injecting drugs, do I start hanging out with other people who inject drugs, or is it because I started hanging out with people who inject drugs, and then I started injecting? From a prevention standpoint, it’s engaging youth in positive networks to prevent the transition.”
The study was supported by funding from the National Institute on Drug Abuse. Dr. Al-Tayyib reported having no disclosures.
SAN DIEGO – Youth and young adults who have transitioned from prescription drug misuse to injection drug use tend to reside in dense social networks, results from a novel study suggest.
“A lot of what we know about the transition from prescription opioids to drug use is from populations that have already transitioned to injection drug use, and we’re asking them retrospectively to tell us about their use,” lead study author Alia Al-Tayyib, PhD, said in an interview at the annual meeting of the College on Problems of Drug Dependence.
In an effort to examine the transition from prescription opioid misuse to injection drug use from a social network perspective, Dr. Al-Tayyib and her associates recruited Denver area residents aged 15-24 years to participate in the Social Networks of Abused Prescription Pills in Youth study between October 2015 and April 2017. Participants were recruited via direct outreach and respondent-driven sampling, which is a peer-referral sampling methodology. Individuals were eligible to participate if they were currently misusing prescription opioids or were currently using heroin after a period of prescription opioid misuse.
Study participants completed interviewer-administered behavioral and social network surveys. People from whom data were collected were referred to as “egos,” and they provided information on people in their social networks called “alters.” As a social network prompt, for example, study participants were asked to “think about people you have contact with who have been involved in your life in a significant way during the past month.”
Participants also were asked about places of aggregation with the prompt, “Where does [this person] hang out?” The egos, alters, and locations are all considered “nodes” in the social network. To examine implications on transition, the researchers examined k-plexes, or subgroups of connected nodes.
Dr. Al-Tayyib, an associate research scientist at Denver Public Health, presented results from 80 ego participants and 489 alters. The mean age of ego participants was 21.4 years, 73% were male, 68% were non-Hispanic white, and 60% reported being homeless in the past 12 months. More than three-quarters of ego participants (80%) reported injection drug use, 14% reported misusing prescription opioids, and 6% reported using heroin without injecting. Of the 489 alters, 45.2% reportedly injected, 5.9% used heroin, and 8.6% misused prescription opioids with at least one of the ego participants.
The researchers observed that study participants who transitioned to injection drug use resided in denser social network regions. “It was really hard to capture people who had not already transitioned to injection drug use, partly because that’s not a behavior that’s easily identifiable,” Dr. Al-Tayyib said. “This study is a one look in time, so it’s hard to know which came first: the chicken or the egg. If I’m injecting drugs, do I start hanging out with other people who inject drugs, or is it because I started hanging out with people who inject drugs, and then I started injecting? From a prevention standpoint, it’s engaging youth in positive networks to prevent the transition.”
The study was supported by funding from the National Institute on Drug Abuse. Dr. Al-Tayyib reported having no disclosures.
SAN DIEGO – Youth and young adults who have transitioned from prescription drug misuse to injection drug use tend to reside in dense social networks, results from a novel study suggest.
“A lot of what we know about the transition from prescription opioids to drug use is from populations that have already transitioned to injection drug use, and we’re asking them retrospectively to tell us about their use,” lead study author Alia Al-Tayyib, PhD, said in an interview at the annual meeting of the College on Problems of Drug Dependence.
In an effort to examine the transition from prescription opioid misuse to injection drug use from a social network perspective, Dr. Al-Tayyib and her associates recruited Denver area residents aged 15-24 years to participate in the Social Networks of Abused Prescription Pills in Youth study between October 2015 and April 2017. Participants were recruited via direct outreach and respondent-driven sampling, which is a peer-referral sampling methodology. Individuals were eligible to participate if they were currently misusing prescription opioids or were currently using heroin after a period of prescription opioid misuse.
Study participants completed interviewer-administered behavioral and social network surveys. People from whom data were collected were referred to as “egos,” and they provided information on people in their social networks called “alters.” As a social network prompt, for example, study participants were asked to “think about people you have contact with who have been involved in your life in a significant way during the past month.”
Participants also were asked about places of aggregation with the prompt, “Where does [this person] hang out?” The egos, alters, and locations are all considered “nodes” in the social network. To examine implications on transition, the researchers examined k-plexes, or subgroups of connected nodes.
Dr. Al-Tayyib, an associate research scientist at Denver Public Health, presented results from 80 ego participants and 489 alters. The mean age of ego participants was 21.4 years, 73% were male, 68% were non-Hispanic white, and 60% reported being homeless in the past 12 months. More than three-quarters of ego participants (80%) reported injection drug use, 14% reported misusing prescription opioids, and 6% reported using heroin without injecting. Of the 489 alters, 45.2% reportedly injected, 5.9% used heroin, and 8.6% misused prescription opioids with at least one of the ego participants.
The researchers observed that study participants who transitioned to injection drug use resided in denser social network regions. “It was really hard to capture people who had not already transitioned to injection drug use, partly because that’s not a behavior that’s easily identifiable,” Dr. Al-Tayyib said. “This study is a one look in time, so it’s hard to know which came first: the chicken or the egg. If I’m injecting drugs, do I start hanging out with other people who inject drugs, or is it because I started hanging out with people who inject drugs, and then I started injecting? From a prevention standpoint, it’s engaging youth in positive networks to prevent the transition.”
The study was supported by funding from the National Institute on Drug Abuse. Dr. Al-Tayyib reported having no disclosures.
AT CPDD 2018
Key clinical point: Prevention efforts are needed to target youth and young adults who misuse prescription drugs before they have transitioned to injection drug use.
Major finding:. Study participants who transitioned to injection drug use resided in denser social network regions.
Study details: Responses from 80 Denver area residents aged 15-24 years who participated in the Social Networks of Abused Prescription Pills in Youth study.
Disclosures: The study was supported by funding from the National Institute on Drug Abuse. Dr. Al-Tayyib reported having no disclosures.
‘Reverse transitions’ from injecting to noninjecting drug use studied
SAN DIEGO – The transition from noninjecting to injecting drug use can be a reversible process, results from a long-term study suggest.
“There’s a common stereotype in popular culture and in academic research that once people start injecting drugs, that will be their dominant route of administration for the rest of their lives,” lead study author Don C. Des Jarlais, PhD, said in an interview at the annual meeting of the College on Problems of Drug Dependence. “We found that people who started injecting injected for several years, but then went back to noninjecting drug use. That so-called ‘reverse transition’ leads to a very big difference in infection with hepatitis C virus as well as reduced risk of overdose and reduced risk of other bacterial infections. Even though these people continued to use drugs, they were doing it in a way that was much safer.”
In an effort to examine the prevalence and characteristics of reverse transitions, Dr. Des Jarlais and his associates recruited injecting and noninjecting drug users aged 18 years and older from the Mount Sinai Beth Israel detoxification and methadone maintenance programs in New York City from 2000 to 2017. The researchers obtained informed consent and conducted a structured interview that included questions on why former injectors had ceased injecting drugs, along with testing for HIV and HCV.
People who were currently injecting were defined as those whose first injection was in 2000 or later and who had injected heroin or cocaine during the 6 months prior to treatment entry. People who formerly injected drugs were defined as those whose first injection was in 2000 or later but who had used heroin or cocaine without injecting drugs during the 6 months prior to treatment entry.
Dr. Des Jarlais, professor of psychiatry at the Icahn School of Medicine at Mount Sinai, New York, reported results from 937 current and 104 former injection drug users. Compared with current injection drug users, former users were older (a mean age of 41 vs. 35, respectively), more likely to be African American (28% vs. 12%), more likely to have received previous methadone treatment (68% vs. 54%), and less likely to be HCV positive (30% vs. 47%; P less than 0.05 for all associations).
The researchers found that 11% of former injection drug users had reverse transitioned to noninjection drug use. Among former injection drug users, the most common reasons for ceasing to inject were “don’t like needles” (30%), “got tired of injecting” (29%), “afraid of overdose” (17%), “concerns about stigma” (16%), and other health concerns (14%).
Dr. Des Jarlais said. “Injecting is messy and it requires private space; it’s not a pleasant way of using drugs compared to just sniffing it. If we’re going to control hepatitis C, we need to find ways of encouraging people that if they’re going to continue to use drugs, they should try to stop injecting.”
The next step in this research area is to develop a more complete understanding of reverse transitions. “These are people doing it on their own, but we don’t have any programs to help them,” he said. “We have needle exchange programs for people to inject safely, but we don’t have any programs where people go from injecting to noninjecting.”
The study received funding support from the National Institute on Drug Abuse. Dr. Des Jarlais reported having no financial disclosures.
SAN DIEGO – The transition from noninjecting to injecting drug use can be a reversible process, results from a long-term study suggest.
“There’s a common stereotype in popular culture and in academic research that once people start injecting drugs, that will be their dominant route of administration for the rest of their lives,” lead study author Don C. Des Jarlais, PhD, said in an interview at the annual meeting of the College on Problems of Drug Dependence. “We found that people who started injecting injected for several years, but then went back to noninjecting drug use. That so-called ‘reverse transition’ leads to a very big difference in infection with hepatitis C virus as well as reduced risk of overdose and reduced risk of other bacterial infections. Even though these people continued to use drugs, they were doing it in a way that was much safer.”
In an effort to examine the prevalence and characteristics of reverse transitions, Dr. Des Jarlais and his associates recruited injecting and noninjecting drug users aged 18 years and older from the Mount Sinai Beth Israel detoxification and methadone maintenance programs in New York City from 2000 to 2017. The researchers obtained informed consent and conducted a structured interview that included questions on why former injectors had ceased injecting drugs, along with testing for HIV and HCV.
People who were currently injecting were defined as those whose first injection was in 2000 or later and who had injected heroin or cocaine during the 6 months prior to treatment entry. People who formerly injected drugs were defined as those whose first injection was in 2000 or later but who had used heroin or cocaine without injecting drugs during the 6 months prior to treatment entry.
Dr. Des Jarlais, professor of psychiatry at the Icahn School of Medicine at Mount Sinai, New York, reported results from 937 current and 104 former injection drug users. Compared with current injection drug users, former users were older (a mean age of 41 vs. 35, respectively), more likely to be African American (28% vs. 12%), more likely to have received previous methadone treatment (68% vs. 54%), and less likely to be HCV positive (30% vs. 47%; P less than 0.05 for all associations).
The researchers found that 11% of former injection drug users had reverse transitioned to noninjection drug use. Among former injection drug users, the most common reasons for ceasing to inject were “don’t like needles” (30%), “got tired of injecting” (29%), “afraid of overdose” (17%), “concerns about stigma” (16%), and other health concerns (14%).
Dr. Des Jarlais said. “Injecting is messy and it requires private space; it’s not a pleasant way of using drugs compared to just sniffing it. If we’re going to control hepatitis C, we need to find ways of encouraging people that if they’re going to continue to use drugs, they should try to stop injecting.”
The next step in this research area is to develop a more complete understanding of reverse transitions. “These are people doing it on their own, but we don’t have any programs to help them,” he said. “We have needle exchange programs for people to inject safely, but we don’t have any programs where people go from injecting to noninjecting.”
The study received funding support from the National Institute on Drug Abuse. Dr. Des Jarlais reported having no financial disclosures.
SAN DIEGO – The transition from noninjecting to injecting drug use can be a reversible process, results from a long-term study suggest.
“There’s a common stereotype in popular culture and in academic research that once people start injecting drugs, that will be their dominant route of administration for the rest of their lives,” lead study author Don C. Des Jarlais, PhD, said in an interview at the annual meeting of the College on Problems of Drug Dependence. “We found that people who started injecting injected for several years, but then went back to noninjecting drug use. That so-called ‘reverse transition’ leads to a very big difference in infection with hepatitis C virus as well as reduced risk of overdose and reduced risk of other bacterial infections. Even though these people continued to use drugs, they were doing it in a way that was much safer.”
In an effort to examine the prevalence and characteristics of reverse transitions, Dr. Des Jarlais and his associates recruited injecting and noninjecting drug users aged 18 years and older from the Mount Sinai Beth Israel detoxification and methadone maintenance programs in New York City from 2000 to 2017. The researchers obtained informed consent and conducted a structured interview that included questions on why former injectors had ceased injecting drugs, along with testing for HIV and HCV.
People who were currently injecting were defined as those whose first injection was in 2000 or later and who had injected heroin or cocaine during the 6 months prior to treatment entry. People who formerly injected drugs were defined as those whose first injection was in 2000 or later but who had used heroin or cocaine without injecting drugs during the 6 months prior to treatment entry.
Dr. Des Jarlais, professor of psychiatry at the Icahn School of Medicine at Mount Sinai, New York, reported results from 937 current and 104 former injection drug users. Compared with current injection drug users, former users were older (a mean age of 41 vs. 35, respectively), more likely to be African American (28% vs. 12%), more likely to have received previous methadone treatment (68% vs. 54%), and less likely to be HCV positive (30% vs. 47%; P less than 0.05 for all associations).
The researchers found that 11% of former injection drug users had reverse transitioned to noninjection drug use. Among former injection drug users, the most common reasons for ceasing to inject were “don’t like needles” (30%), “got tired of injecting” (29%), “afraid of overdose” (17%), “concerns about stigma” (16%), and other health concerns (14%).
Dr. Des Jarlais said. “Injecting is messy and it requires private space; it’s not a pleasant way of using drugs compared to just sniffing it. If we’re going to control hepatitis C, we need to find ways of encouraging people that if they’re going to continue to use drugs, they should try to stop injecting.”
The next step in this research area is to develop a more complete understanding of reverse transitions. “These are people doing it on their own, but we don’t have any programs to help them,” he said. “We have needle exchange programs for people to inject safely, but we don’t have any programs where people go from injecting to noninjecting.”
The study received funding support from the National Institute on Drug Abuse. Dr. Des Jarlais reported having no financial disclosures.
AT CPDD 2018
Key clinical point: To control hepatitis C, patients who continue to use drugs should be encouraged to stop injecting.
Major finding: Among former injection drug users, 11% had reverse transitioned to noninjection drug use.
Study details: A study of 937 current and 104 former injection drug users between 2000 and 2017.
Disclosures: The study received funding support from the National Institute on Drug Abuse. Dr. Des Jarlais reported having no financial disclosures.
Zolpidem does not boost cannabis abstinence during treatment
SAN DIEGO – Disturbed sleep is one of the symptoms of withdrawal from marijuana, and it can wreak havoc on the lives of people with cannabis use disorder who are trying to quit. Now, a new study provides more evidence about the problem and suggests that the sleep aid zolpidem is not a solution on its own.
Zolpidem seemed to help subjects sleep better, but the effect lasted only as long as they took the drug. And .
“Zolpidem or other hypnotics may have some efficacy as a pharmacotherapy to relieve short-term sleep disruption in the treatment of cannabis use disorder. But they should only be used in cases where abstinence-induced insomnia is a significant barrier to cessation and only in combination with other evidence-based interventions to address key aspects of cannabis use disorder,” study coauthor Dustin C. Lee, PhD, of Johns Hopkins University, Baltimore, said in an interview. He presented the study findings at the annual meeting of the College on Problems of Drug Dependence.
Previous research, including studies by some of the authors of the new report, suggests that people trying to withdraw from cannabis often suffer from sleep disturbances.
In a 2010 study, for instance, researchers interviewed 469 adult cannabis users in the Baltimore area who had tried to quit outside of treatment programs. Nearly half reported trouble falling asleep, while 20%-36% reported sleep-related symptoms, such as sleeping more or less than usual, having unusual dreams, and waking during the night (Drug Alcohol Depend. 2010 Sep 1;111[1-2]:120-7).
Another factor could be at play: Cannabis users may sleep better while they use the drug, then lose the benefit when they try to withdraw.
“Studies have demonstrated that acute use of cannabis reduces sleep latency and increases stage 3 sleep, informally referred to as ‘deep’ or ‘slow-wave’ sleep, which means individuals fall asleep faster and remain in deep sleep longer after using cannabis,” Dr. Lee said.
Whatever the explanation, the sleep problems during withdrawal are not helpful to users who are trying to quit. “Research indicates that cannabis cessation results in sleep problems that are a barrier to quitting,” Dr. Lee said.
For the new study, Dr. Lee and his colleagues randomly assigned 127 adults – all in a 12-week clinical trial of cannabis use disorder treatment – to receive extended-release zolpidem or placebo.
Participants underwent urine screens to test for drug use and ambulatory polysomnography to measure sleep.
A preliminary analysis found that those who received zolpidem had higher rates of cannabis abstinence during the 12 weeks and at end of treatment. But analysis showed that the differences were not statistically significant, Dr. Lee said, “which suggests that sleep is not the predominant factor driving successful cessation attempts.”
Researchers also found that sleep efficiency and sleep onset latency deteriorated to a clinically significant degree in week 1 of the study for those who took the placebo (mean sleep efficiency fell from 82% to 74%, while sleep onset latency increased from 28 to 82 minutes).
The zolpidem group did not see any significant change in sleep efficiency or sleep onset latency. However, those participants showed signs of rebound insomnia after they stopped taking zolpidem.
As for the risk of abuse of zolpidem, Dr. Lee said: “We did not see any indication of abuse among the individuals who participated in our study. We monitored this via quantitative urine toxicology testing and remote medication adherence monitoring.”
Moving forward, he said, zolpidem “may have some efficacy as a short-term therapy for sleep disruption in a subset of cannabis users. More research is needed to further evaluate the efficacy of zolpidem or other hypnotic medications in individuals who differ in withdrawal severity or demographics.”
Dr. Lee said evaluating behavioral sleep treatments would be a logical next-step in light of his team’s data.
The National Institute on Drug Abuse funded the study. Three of the authors reported no relevant disclosures, and one reported consulting/advisory links to several drug companies and several state-licensed medical cannabis cultivation or dispensary businesses.
SAN DIEGO – Disturbed sleep is one of the symptoms of withdrawal from marijuana, and it can wreak havoc on the lives of people with cannabis use disorder who are trying to quit. Now, a new study provides more evidence about the problem and suggests that the sleep aid zolpidem is not a solution on its own.
Zolpidem seemed to help subjects sleep better, but the effect lasted only as long as they took the drug. And .
“Zolpidem or other hypnotics may have some efficacy as a pharmacotherapy to relieve short-term sleep disruption in the treatment of cannabis use disorder. But they should only be used in cases where abstinence-induced insomnia is a significant barrier to cessation and only in combination with other evidence-based interventions to address key aspects of cannabis use disorder,” study coauthor Dustin C. Lee, PhD, of Johns Hopkins University, Baltimore, said in an interview. He presented the study findings at the annual meeting of the College on Problems of Drug Dependence.
Previous research, including studies by some of the authors of the new report, suggests that people trying to withdraw from cannabis often suffer from sleep disturbances.
In a 2010 study, for instance, researchers interviewed 469 adult cannabis users in the Baltimore area who had tried to quit outside of treatment programs. Nearly half reported trouble falling asleep, while 20%-36% reported sleep-related symptoms, such as sleeping more or less than usual, having unusual dreams, and waking during the night (Drug Alcohol Depend. 2010 Sep 1;111[1-2]:120-7).
Another factor could be at play: Cannabis users may sleep better while they use the drug, then lose the benefit when they try to withdraw.
“Studies have demonstrated that acute use of cannabis reduces sleep latency and increases stage 3 sleep, informally referred to as ‘deep’ or ‘slow-wave’ sleep, which means individuals fall asleep faster and remain in deep sleep longer after using cannabis,” Dr. Lee said.
Whatever the explanation, the sleep problems during withdrawal are not helpful to users who are trying to quit. “Research indicates that cannabis cessation results in sleep problems that are a barrier to quitting,” Dr. Lee said.
For the new study, Dr. Lee and his colleagues randomly assigned 127 adults – all in a 12-week clinical trial of cannabis use disorder treatment – to receive extended-release zolpidem or placebo.
Participants underwent urine screens to test for drug use and ambulatory polysomnography to measure sleep.
A preliminary analysis found that those who received zolpidem had higher rates of cannabis abstinence during the 12 weeks and at end of treatment. But analysis showed that the differences were not statistically significant, Dr. Lee said, “which suggests that sleep is not the predominant factor driving successful cessation attempts.”
Researchers also found that sleep efficiency and sleep onset latency deteriorated to a clinically significant degree in week 1 of the study for those who took the placebo (mean sleep efficiency fell from 82% to 74%, while sleep onset latency increased from 28 to 82 minutes).
The zolpidem group did not see any significant change in sleep efficiency or sleep onset latency. However, those participants showed signs of rebound insomnia after they stopped taking zolpidem.
As for the risk of abuse of zolpidem, Dr. Lee said: “We did not see any indication of abuse among the individuals who participated in our study. We monitored this via quantitative urine toxicology testing and remote medication adherence monitoring.”
Moving forward, he said, zolpidem “may have some efficacy as a short-term therapy for sleep disruption in a subset of cannabis users. More research is needed to further evaluate the efficacy of zolpidem or other hypnotic medications in individuals who differ in withdrawal severity or demographics.”
Dr. Lee said evaluating behavioral sleep treatments would be a logical next-step in light of his team’s data.
The National Institute on Drug Abuse funded the study. Three of the authors reported no relevant disclosures, and one reported consulting/advisory links to several drug companies and several state-licensed medical cannabis cultivation or dispensary businesses.
SAN DIEGO – Disturbed sleep is one of the symptoms of withdrawal from marijuana, and it can wreak havoc on the lives of people with cannabis use disorder who are trying to quit. Now, a new study provides more evidence about the problem and suggests that the sleep aid zolpidem is not a solution on its own.
Zolpidem seemed to help subjects sleep better, but the effect lasted only as long as they took the drug. And .
“Zolpidem or other hypnotics may have some efficacy as a pharmacotherapy to relieve short-term sleep disruption in the treatment of cannabis use disorder. But they should only be used in cases where abstinence-induced insomnia is a significant barrier to cessation and only in combination with other evidence-based interventions to address key aspects of cannabis use disorder,” study coauthor Dustin C. Lee, PhD, of Johns Hopkins University, Baltimore, said in an interview. He presented the study findings at the annual meeting of the College on Problems of Drug Dependence.
Previous research, including studies by some of the authors of the new report, suggests that people trying to withdraw from cannabis often suffer from sleep disturbances.
In a 2010 study, for instance, researchers interviewed 469 adult cannabis users in the Baltimore area who had tried to quit outside of treatment programs. Nearly half reported trouble falling asleep, while 20%-36% reported sleep-related symptoms, such as sleeping more or less than usual, having unusual dreams, and waking during the night (Drug Alcohol Depend. 2010 Sep 1;111[1-2]:120-7).
Another factor could be at play: Cannabis users may sleep better while they use the drug, then lose the benefit when they try to withdraw.
“Studies have demonstrated that acute use of cannabis reduces sleep latency and increases stage 3 sleep, informally referred to as ‘deep’ or ‘slow-wave’ sleep, which means individuals fall asleep faster and remain in deep sleep longer after using cannabis,” Dr. Lee said.
Whatever the explanation, the sleep problems during withdrawal are not helpful to users who are trying to quit. “Research indicates that cannabis cessation results in sleep problems that are a barrier to quitting,” Dr. Lee said.
For the new study, Dr. Lee and his colleagues randomly assigned 127 adults – all in a 12-week clinical trial of cannabis use disorder treatment – to receive extended-release zolpidem or placebo.
Participants underwent urine screens to test for drug use and ambulatory polysomnography to measure sleep.
A preliminary analysis found that those who received zolpidem had higher rates of cannabis abstinence during the 12 weeks and at end of treatment. But analysis showed that the differences were not statistically significant, Dr. Lee said, “which suggests that sleep is not the predominant factor driving successful cessation attempts.”
Researchers also found that sleep efficiency and sleep onset latency deteriorated to a clinically significant degree in week 1 of the study for those who took the placebo (mean sleep efficiency fell from 82% to 74%, while sleep onset latency increased from 28 to 82 minutes).
The zolpidem group did not see any significant change in sleep efficiency or sleep onset latency. However, those participants showed signs of rebound insomnia after they stopped taking zolpidem.
As for the risk of abuse of zolpidem, Dr. Lee said: “We did not see any indication of abuse among the individuals who participated in our study. We monitored this via quantitative urine toxicology testing and remote medication adherence monitoring.”
Moving forward, he said, zolpidem “may have some efficacy as a short-term therapy for sleep disruption in a subset of cannabis users. More research is needed to further evaluate the efficacy of zolpidem or other hypnotic medications in individuals who differ in withdrawal severity or demographics.”
Dr. Lee said evaluating behavioral sleep treatments would be a logical next-step in light of his team’s data.
The National Institute on Drug Abuse funded the study. Three of the authors reported no relevant disclosures, and one reported consulting/advisory links to several drug companies and several state-licensed medical cannabis cultivation or dispensary businesses.
REPORTING FROM CPDD 2018
Key clinical point: Zolpidem does not boost rates of abstinence during treatment for cannabis use disorder.
Major finding: Researchers did not find a statistically significant difference in cannabis abstinence rates between subjects who took zolpidem during treatment and those who did not.
Study details: Randomized, placebo-controlled trial of 127 adults with cannabis use disorder, all in a 12-week clinical trial of a treatment program, who received extended-release zolpidem or placebo.
Disclosures: Three of the authors reported no relevant disclosures, and one reported consulting/advisory links to several drug companies and several state-licensed medical cannabis cultivation or dispensary businesses.
Fentanyl fears drive many opioid users, interviews suggest
SAN DIEGO – Many opioid users on the street are embracing homegrown “risk reduction” techniques to make sure they avoid the danger of fentanyl-laced heroin, while others seek out batches that have caused fatal overdoses because they figure these supplies must be extra-strong and desirable. “Anytime I hear that somebody OD’d off something,” said one user, “... I was like, ‘Oh, that stuff must be good. Where can I get it?’ ”
So say opioid users who are opening up to researchers about the deadly new American drug landscape.
There’s one common thread, said Daniel Ciccarone, MD, MPH, who presented findings from his team’s interviews at the annual meeting of the College on Problems of Drug Dependence. Attitudes about fentanyl are shifting, but not enough to turn the drug – which often is available instead of heroin – into a major crowd-pleaser.
“When we first went into the field, there was a strong negative opinion about fentanyl. It was not wanted; it was imposed,” said Dr. Ciccarone of the University of California at San Francisco. “While there is some shift now, in which some do want or like the fentanyl, it is not strong enough to have shifted the culture. i.e., .”
But fentanyl still is rampant, often making its way to users who do not want and might be actively trying to avoid it. According to the National Institute on Drug Abuse, or NIDA, fentanyl and fentanyl analogs were linked to more than 20,000 of the more than 64,000 fatal U.S. drug overdoses in 2016.
“The risks are greater with fentanyl and not just because it is more potent than heroin,” Dr. Ciccarone said. In addition, “the form (fentanyl vs. fentanyl analogs) and purity shifts on a daily basis, and it’s mixed with heroin in varying amounts. It is these vicissitudes in fentanyl/heroin types and purities that make the street blends dangerous for overdose.”
Dr. Ciccarone and his colleagues interviewed opioid users in Baltimore; Charleston, W. Va.; Lawrence and Lowell, Mass.; and Chicago. Information about some of the interviews was published previously (Intl J Drug Policy. 2017 Aug;46;146-55).
In another study whose results were released at the CPDD conference, researchers from Dartmouth College, Hanover, N.H., interviewed 76 opioid users (91% were white, average age was 34, half were female, and almost all had a history of substance abuse treatment).
Among the other findings of the studies:
- Some opioid users are shocked by the adulteration of heroin by fentanyl, and even dealers are surprised: “When we cut the dope, we don’t use fentanyl. The problem was that we were buying the dope already dirty with that, and we didn’t know it,” said a 42-year-old man from Lawrence, Mass.
- In the New Hampshire interviews, 84% of participants said fentanyl is the leading cause of overdose in the state. “Due to the fentanyl and the heroin, that’s how everyone that I know ended up passing away recently,” said one user.
- Also in New Hampshire, 84% of users interviewed said they’d used fentanyl before, accidentally in some cases. Also, study coauthor Andrea L. Meier said in an interview, “67% of users reported having a prescription for opioids in their lifetime due to some kind of illness or injury. Some were short-term prescriptions (injuries, C-sections, tooth extractions); others were prescribed long-term due to chronic pain or illness.”
Some say pursue fentanyl
In the New Hampshire interviews, 25% of the 84% who’d used fentanyl said they actively seek it out, with one expressing a preference for the “real dope” (heroin laced with fentanyl) versus the “maintenance dope” of heroin alone. Ms. Meier explained what that means: “We’ve heard that once you use fentanyl or fentanyl-laced heroin, heroin doesn’t adequately manage your withdrawal symptoms or give enough of a high. So they will use heroin to get by, but they really want fentanyl or fentanyl-laced heroin.”
She added: “We’ve learned that users are seeking fentanyl due to its potency (a stronger, better high with quicker onset than heroin), cost (cheaper than heroin, so more “bang for your buck”), and once they use fentanyl or fentanyl-laced heroin, heroin doesn’t have the same effect/high.”
As for the risk of overdose, “people want the best high they can get at the cheapest cost,” she said.” They presume it will be potent enough to produce an exceptional high but [they won’t] die from an overdose due to being sufficiently tolerant to handle it. Also, some just felt hopeless and weren’t afraid of an OD.”
Comments from users about fentanyl
- “The high is wonderful. It’s splendidly wonderful. It’s magnified heroin feeling by a great number,” said a 45-year-old man from Baltimore.
- “You spend the same amount of money or even less for it, and you’re getting 3 times as high as you did on heroin,” said one user in New Hampshire. “Who wouldn’t want that?”
Risk-reduction techniques embraced
- In Baltimore, a 39-year-old woman said: “I have a lot of associates that are letting me know, ‘Don’t go to that place because they selling fentanyl.’ ”
- Some users test their heroin. “Like when I get stuff I don’t know what it is, I do a little bit before I do something that I feel,” a Lawrence, Mass., female user in her 20s said. “Like, I want to kind of scale out how much I want to do. Because I don’t want to die. But these people are just doing a gram shot and just ... my friend just died 2 days ago.”
Dr. Ciccarone said some of the biggest proponents of harm-reduction among users were African Americans aged 60 and older who had used for many decades.
“They fear fentanyl and are using old-school harm reduction strategies for staying safer: “tooting” (snorting) and tester shots (small injections to test the quality),” he said. “These may seem like minor strategies, but if enough of the population applies them to their daily drug use, many deaths would be averted. In this crisis, we need all the wisdom we can get, so we should listen to these elders.”
Dr. Ciccarone’s research was funded by the National Institutes of Health and NIDA. Dr. Ciccarone reported no relevant disclosures. The Dartmouth College study was funded by NIDA, and those authors reported no relevant disclosures.
SAN DIEGO – Many opioid users on the street are embracing homegrown “risk reduction” techniques to make sure they avoid the danger of fentanyl-laced heroin, while others seek out batches that have caused fatal overdoses because they figure these supplies must be extra-strong and desirable. “Anytime I hear that somebody OD’d off something,” said one user, “... I was like, ‘Oh, that stuff must be good. Where can I get it?’ ”
So say opioid users who are opening up to researchers about the deadly new American drug landscape.
There’s one common thread, said Daniel Ciccarone, MD, MPH, who presented findings from his team’s interviews at the annual meeting of the College on Problems of Drug Dependence. Attitudes about fentanyl are shifting, but not enough to turn the drug – which often is available instead of heroin – into a major crowd-pleaser.
“When we first went into the field, there was a strong negative opinion about fentanyl. It was not wanted; it was imposed,” said Dr. Ciccarone of the University of California at San Francisco. “While there is some shift now, in which some do want or like the fentanyl, it is not strong enough to have shifted the culture. i.e., .”
But fentanyl still is rampant, often making its way to users who do not want and might be actively trying to avoid it. According to the National Institute on Drug Abuse, or NIDA, fentanyl and fentanyl analogs were linked to more than 20,000 of the more than 64,000 fatal U.S. drug overdoses in 2016.
“The risks are greater with fentanyl and not just because it is more potent than heroin,” Dr. Ciccarone said. In addition, “the form (fentanyl vs. fentanyl analogs) and purity shifts on a daily basis, and it’s mixed with heroin in varying amounts. It is these vicissitudes in fentanyl/heroin types and purities that make the street blends dangerous for overdose.”
Dr. Ciccarone and his colleagues interviewed opioid users in Baltimore; Charleston, W. Va.; Lawrence and Lowell, Mass.; and Chicago. Information about some of the interviews was published previously (Intl J Drug Policy. 2017 Aug;46;146-55).
In another study whose results were released at the CPDD conference, researchers from Dartmouth College, Hanover, N.H., interviewed 76 opioid users (91% were white, average age was 34, half were female, and almost all had a history of substance abuse treatment).
Among the other findings of the studies:
- Some opioid users are shocked by the adulteration of heroin by fentanyl, and even dealers are surprised: “When we cut the dope, we don’t use fentanyl. The problem was that we were buying the dope already dirty with that, and we didn’t know it,” said a 42-year-old man from Lawrence, Mass.
- In the New Hampshire interviews, 84% of participants said fentanyl is the leading cause of overdose in the state. “Due to the fentanyl and the heroin, that’s how everyone that I know ended up passing away recently,” said one user.
- Also in New Hampshire, 84% of users interviewed said they’d used fentanyl before, accidentally in some cases. Also, study coauthor Andrea L. Meier said in an interview, “67% of users reported having a prescription for opioids in their lifetime due to some kind of illness or injury. Some were short-term prescriptions (injuries, C-sections, tooth extractions); others were prescribed long-term due to chronic pain or illness.”
Some say pursue fentanyl
In the New Hampshire interviews, 25% of the 84% who’d used fentanyl said they actively seek it out, with one expressing a preference for the “real dope” (heroin laced with fentanyl) versus the “maintenance dope” of heroin alone. Ms. Meier explained what that means: “We’ve heard that once you use fentanyl or fentanyl-laced heroin, heroin doesn’t adequately manage your withdrawal symptoms or give enough of a high. So they will use heroin to get by, but they really want fentanyl or fentanyl-laced heroin.”
She added: “We’ve learned that users are seeking fentanyl due to its potency (a stronger, better high with quicker onset than heroin), cost (cheaper than heroin, so more “bang for your buck”), and once they use fentanyl or fentanyl-laced heroin, heroin doesn’t have the same effect/high.”
As for the risk of overdose, “people want the best high they can get at the cheapest cost,” she said.” They presume it will be potent enough to produce an exceptional high but [they won’t] die from an overdose due to being sufficiently tolerant to handle it. Also, some just felt hopeless and weren’t afraid of an OD.”
Comments from users about fentanyl
- “The high is wonderful. It’s splendidly wonderful. It’s magnified heroin feeling by a great number,” said a 45-year-old man from Baltimore.
- “You spend the same amount of money or even less for it, and you’re getting 3 times as high as you did on heroin,” said one user in New Hampshire. “Who wouldn’t want that?”
Risk-reduction techniques embraced
- In Baltimore, a 39-year-old woman said: “I have a lot of associates that are letting me know, ‘Don’t go to that place because they selling fentanyl.’ ”
- Some users test their heroin. “Like when I get stuff I don’t know what it is, I do a little bit before I do something that I feel,” a Lawrence, Mass., female user in her 20s said. “Like, I want to kind of scale out how much I want to do. Because I don’t want to die. But these people are just doing a gram shot and just ... my friend just died 2 days ago.”
Dr. Ciccarone said some of the biggest proponents of harm-reduction among users were African Americans aged 60 and older who had used for many decades.
“They fear fentanyl and are using old-school harm reduction strategies for staying safer: “tooting” (snorting) and tester shots (small injections to test the quality),” he said. “These may seem like minor strategies, but if enough of the population applies them to their daily drug use, many deaths would be averted. In this crisis, we need all the wisdom we can get, so we should listen to these elders.”
Dr. Ciccarone’s research was funded by the National Institutes of Health and NIDA. Dr. Ciccarone reported no relevant disclosures. The Dartmouth College study was funded by NIDA, and those authors reported no relevant disclosures.
SAN DIEGO – Many opioid users on the street are embracing homegrown “risk reduction” techniques to make sure they avoid the danger of fentanyl-laced heroin, while others seek out batches that have caused fatal overdoses because they figure these supplies must be extra-strong and desirable. “Anytime I hear that somebody OD’d off something,” said one user, “... I was like, ‘Oh, that stuff must be good. Where can I get it?’ ”
So say opioid users who are opening up to researchers about the deadly new American drug landscape.
There’s one common thread, said Daniel Ciccarone, MD, MPH, who presented findings from his team’s interviews at the annual meeting of the College on Problems of Drug Dependence. Attitudes about fentanyl are shifting, but not enough to turn the drug – which often is available instead of heroin – into a major crowd-pleaser.
“When we first went into the field, there was a strong negative opinion about fentanyl. It was not wanted; it was imposed,” said Dr. Ciccarone of the University of California at San Francisco. “While there is some shift now, in which some do want or like the fentanyl, it is not strong enough to have shifted the culture. i.e., .”
But fentanyl still is rampant, often making its way to users who do not want and might be actively trying to avoid it. According to the National Institute on Drug Abuse, or NIDA, fentanyl and fentanyl analogs were linked to more than 20,000 of the more than 64,000 fatal U.S. drug overdoses in 2016.
“The risks are greater with fentanyl and not just because it is more potent than heroin,” Dr. Ciccarone said. In addition, “the form (fentanyl vs. fentanyl analogs) and purity shifts on a daily basis, and it’s mixed with heroin in varying amounts. It is these vicissitudes in fentanyl/heroin types and purities that make the street blends dangerous for overdose.”
Dr. Ciccarone and his colleagues interviewed opioid users in Baltimore; Charleston, W. Va.; Lawrence and Lowell, Mass.; and Chicago. Information about some of the interviews was published previously (Intl J Drug Policy. 2017 Aug;46;146-55).
In another study whose results were released at the CPDD conference, researchers from Dartmouth College, Hanover, N.H., interviewed 76 opioid users (91% were white, average age was 34, half were female, and almost all had a history of substance abuse treatment).
Among the other findings of the studies:
- Some opioid users are shocked by the adulteration of heroin by fentanyl, and even dealers are surprised: “When we cut the dope, we don’t use fentanyl. The problem was that we were buying the dope already dirty with that, and we didn’t know it,” said a 42-year-old man from Lawrence, Mass.
- In the New Hampshire interviews, 84% of participants said fentanyl is the leading cause of overdose in the state. “Due to the fentanyl and the heroin, that’s how everyone that I know ended up passing away recently,” said one user.
- Also in New Hampshire, 84% of users interviewed said they’d used fentanyl before, accidentally in some cases. Also, study coauthor Andrea L. Meier said in an interview, “67% of users reported having a prescription for opioids in their lifetime due to some kind of illness or injury. Some were short-term prescriptions (injuries, C-sections, tooth extractions); others were prescribed long-term due to chronic pain or illness.”
Some say pursue fentanyl
In the New Hampshire interviews, 25% of the 84% who’d used fentanyl said they actively seek it out, with one expressing a preference for the “real dope” (heroin laced with fentanyl) versus the “maintenance dope” of heroin alone. Ms. Meier explained what that means: “We’ve heard that once you use fentanyl or fentanyl-laced heroin, heroin doesn’t adequately manage your withdrawal symptoms or give enough of a high. So they will use heroin to get by, but they really want fentanyl or fentanyl-laced heroin.”
She added: “We’ve learned that users are seeking fentanyl due to its potency (a stronger, better high with quicker onset than heroin), cost (cheaper than heroin, so more “bang for your buck”), and once they use fentanyl or fentanyl-laced heroin, heroin doesn’t have the same effect/high.”
As for the risk of overdose, “people want the best high they can get at the cheapest cost,” she said.” They presume it will be potent enough to produce an exceptional high but [they won’t] die from an overdose due to being sufficiently tolerant to handle it. Also, some just felt hopeless and weren’t afraid of an OD.”
Comments from users about fentanyl
- “The high is wonderful. It’s splendidly wonderful. It’s magnified heroin feeling by a great number,” said a 45-year-old man from Baltimore.
- “You spend the same amount of money or even less for it, and you’re getting 3 times as high as you did on heroin,” said one user in New Hampshire. “Who wouldn’t want that?”
Risk-reduction techniques embraced
- In Baltimore, a 39-year-old woman said: “I have a lot of associates that are letting me know, ‘Don’t go to that place because they selling fentanyl.’ ”
- Some users test their heroin. “Like when I get stuff I don’t know what it is, I do a little bit before I do something that I feel,” a Lawrence, Mass., female user in her 20s said. “Like, I want to kind of scale out how much I want to do. Because I don’t want to die. But these people are just doing a gram shot and just ... my friend just died 2 days ago.”
Dr. Ciccarone said some of the biggest proponents of harm-reduction among users were African Americans aged 60 and older who had used for many decades.
“They fear fentanyl and are using old-school harm reduction strategies for staying safer: “tooting” (snorting) and tester shots (small injections to test the quality),” he said. “These may seem like minor strategies, but if enough of the population applies them to their daily drug use, many deaths would be averted. In this crisis, we need all the wisdom we can get, so we should listen to these elders.”
Dr. Ciccarone’s research was funded by the National Institutes of Health and NIDA. Dr. Ciccarone reported no relevant disclosures. The Dartmouth College study was funded by NIDA, and those authors reported no relevant disclosures.
REPORTING FROM CPDD 2018
Methamphetamine use climbing among opioid users
SAN DIEGO – As the deadly opioid epidemic continues, a new study suggests that a fast-rising number of users are turning to another drug of abuse – methamphetamine. In some cases, a researcher says, their co-use is reminiscent of the fad for “speedball” mixtures of cocaine and heroin.
During 2011-2017, the percentage of surveyed opioid users seeking treatment who reported also using methamphetamine over the past month skyrocketed from 19% to 34%, researchers reported at the 2018 annual meeting of the College on Problems of Drug Dependence.
Use of crystal meth specifically went up by 82% and the use of prescription stimulants rose by 15%. By contrast, use of marijuana went up by just 6%, while the use of muscle relaxants and prescription sleep drugs fell by more than half.
The findings matter, because the use of multiple illicit drugs is even more dangerous than one alone, said study coauthor and doctoral candidate Matthew S. Ellis, of Washington University in St. Louis, in an interview. “Illicit opioids carry their own serious risks such as unknown purity, not knowing if heroin is laced with fentanyl, or inexperience of users who are used to clearly marked prescription pills. Add in a secondary drug, also often used in non-oral ways, and your risk for overdose is going to significantly increase.”
The rising use of methamphetamine, which comes in such forms as crystal meth, has been overshadowed by news about the opioid epidemic. Still, as a 2018 Lancet report put it, “while the opioid crisis has exploded, the lull in the methamphetamine epidemic has quietly and swiftly reversed course, now accounting for 11% of the total number of overdose deaths.”
In regard to co-use of opioids and methamphetamines, the report said, “in states including Wisconsin and Oregon, new patterns suggest they are beginning to overlap as increasing numbers of people use both drugs” (Lancet. 2018 Feb. 24;391[10122]:713).
Meanwhile, the New York Times published a story in February 2018 headlined “Meth, the forgotten killer, is back. And it’s everywhere.” It noted that meth overdose deaths in Oregon outpace those from opioids and added: “At the United States border, agents are seizing 10-20 times the amounts they did a decade ago. Methamphetamine, experts say, has never been purer, cheaper, or more lethal.”
Overall, there’s little known about co-use of opioids and methamphetamines, said study lead author Mr. Ellis. “The reason for this is that opioid use patterns and populations of users have drastically changed in the past 20 years, and continue to do so,” he said. “Methamphetamine is becoming increasingly available at the same time that heroin and illicit fentanyl are as well. Reports suggest that the United States has shifted from a market of home-grown methamphetamine to that manufactured and sent from other countries, creating a broader market than previously seen.”
For the new study, Mr. Ellis and his colleagues examined statistics from a U.S. surveillance program of opioid users entering substance abuse programs. They focused on 13,521 participants in 47 states during 2011-2017.
Of 12 drug classes examined, only co-use of methamphetamine rose significantly over the 6-year period, Mr. Ellis said.
Among demographic and geographic groups, the researchers saw the largest increases in co-use of the two drugs in the West, Northeast, and Midwest regions, in rural and suburban areas, among groups aged 18-44 years, and among whites.
Why is co-use among opioid users increasing? “We have begun to do some qualitative work with a number of participants suggesting they use opioids and methamphetamine to balance each other out,” Mr. Ellis said. “So an addict can use opioids, but if they need to go to work, they can reinvigorate themselves with methamphetamine.”
Mr. Ellis said “this is not necessarily a new trend,” noting that the co-use of the drugs is akin to the “speedball” – a mixture of cocaine and heroin designed to blend their opposite modes of action.
However, Mr. Ellis said, “ The increases in production and spread of illicit opioids and methamphetamine into an existing market of those previously using prescription opioids was a perfect storm for these two drugs to be a problem, both separately and together.”
He said researchers also are finding that “if methamphetamine is the only thing an opioid addict can find, they will use it to stave off withdrawals as well.”
Indeed, National Public Radio reported in June 2018 that “as opioids are becoming harder to obtain, more and more users are turning to cheap methamphetamine” in Ohio’s tiny Vinton County, near Columbus.
Moving forward, Mr. Ellis said, “we cannot treat substance use in a silo of a single drug. If we attempt to treat opioid abusers by simply treating their opioid abuse – and not other drugs – then we have less of a chance of success. More of a focus needs to be put on the fact that the vast majority of opioid abusers are polysubstance users.”
The study is funded by the RADARS (Researched Abuse, Diversion and Addiction-Related Surveillance) System, an independent, nonprofit postmarketing surveillance system supported by subscription fees from pharmaceutical manufacturers that use RADARS data to track medication use and meet regulatory obligations. The study authors report no relevant disclosures.
SAN DIEGO – As the deadly opioid epidemic continues, a new study suggests that a fast-rising number of users are turning to another drug of abuse – methamphetamine. In some cases, a researcher says, their co-use is reminiscent of the fad for “speedball” mixtures of cocaine and heroin.
During 2011-2017, the percentage of surveyed opioid users seeking treatment who reported also using methamphetamine over the past month skyrocketed from 19% to 34%, researchers reported at the 2018 annual meeting of the College on Problems of Drug Dependence.
Use of crystal meth specifically went up by 82% and the use of prescription stimulants rose by 15%. By contrast, use of marijuana went up by just 6%, while the use of muscle relaxants and prescription sleep drugs fell by more than half.
The findings matter, because the use of multiple illicit drugs is even more dangerous than one alone, said study coauthor and doctoral candidate Matthew S. Ellis, of Washington University in St. Louis, in an interview. “Illicit opioids carry their own serious risks such as unknown purity, not knowing if heroin is laced with fentanyl, or inexperience of users who are used to clearly marked prescription pills. Add in a secondary drug, also often used in non-oral ways, and your risk for overdose is going to significantly increase.”
The rising use of methamphetamine, which comes in such forms as crystal meth, has been overshadowed by news about the opioid epidemic. Still, as a 2018 Lancet report put it, “while the opioid crisis has exploded, the lull in the methamphetamine epidemic has quietly and swiftly reversed course, now accounting for 11% of the total number of overdose deaths.”
In regard to co-use of opioids and methamphetamines, the report said, “in states including Wisconsin and Oregon, new patterns suggest they are beginning to overlap as increasing numbers of people use both drugs” (Lancet. 2018 Feb. 24;391[10122]:713).
Meanwhile, the New York Times published a story in February 2018 headlined “Meth, the forgotten killer, is back. And it’s everywhere.” It noted that meth overdose deaths in Oregon outpace those from opioids and added: “At the United States border, agents are seizing 10-20 times the amounts they did a decade ago. Methamphetamine, experts say, has never been purer, cheaper, or more lethal.”
Overall, there’s little known about co-use of opioids and methamphetamines, said study lead author Mr. Ellis. “The reason for this is that opioid use patterns and populations of users have drastically changed in the past 20 years, and continue to do so,” he said. “Methamphetamine is becoming increasingly available at the same time that heroin and illicit fentanyl are as well. Reports suggest that the United States has shifted from a market of home-grown methamphetamine to that manufactured and sent from other countries, creating a broader market than previously seen.”
For the new study, Mr. Ellis and his colleagues examined statistics from a U.S. surveillance program of opioid users entering substance abuse programs. They focused on 13,521 participants in 47 states during 2011-2017.
Of 12 drug classes examined, only co-use of methamphetamine rose significantly over the 6-year period, Mr. Ellis said.
Among demographic and geographic groups, the researchers saw the largest increases in co-use of the two drugs in the West, Northeast, and Midwest regions, in rural and suburban areas, among groups aged 18-44 years, and among whites.
Why is co-use among opioid users increasing? “We have begun to do some qualitative work with a number of participants suggesting they use opioids and methamphetamine to balance each other out,” Mr. Ellis said. “So an addict can use opioids, but if they need to go to work, they can reinvigorate themselves with methamphetamine.”
Mr. Ellis said “this is not necessarily a new trend,” noting that the co-use of the drugs is akin to the “speedball” – a mixture of cocaine and heroin designed to blend their opposite modes of action.
However, Mr. Ellis said, “ The increases in production and spread of illicit opioids and methamphetamine into an existing market of those previously using prescription opioids was a perfect storm for these two drugs to be a problem, both separately and together.”
He said researchers also are finding that “if methamphetamine is the only thing an opioid addict can find, they will use it to stave off withdrawals as well.”
Indeed, National Public Radio reported in June 2018 that “as opioids are becoming harder to obtain, more and more users are turning to cheap methamphetamine” in Ohio’s tiny Vinton County, near Columbus.
Moving forward, Mr. Ellis said, “we cannot treat substance use in a silo of a single drug. If we attempt to treat opioid abusers by simply treating their opioid abuse – and not other drugs – then we have less of a chance of success. More of a focus needs to be put on the fact that the vast majority of opioid abusers are polysubstance users.”
The study is funded by the RADARS (Researched Abuse, Diversion and Addiction-Related Surveillance) System, an independent, nonprofit postmarketing surveillance system supported by subscription fees from pharmaceutical manufacturers that use RADARS data to track medication use and meet regulatory obligations. The study authors report no relevant disclosures.
SAN DIEGO – As the deadly opioid epidemic continues, a new study suggests that a fast-rising number of users are turning to another drug of abuse – methamphetamine. In some cases, a researcher says, their co-use is reminiscent of the fad for “speedball” mixtures of cocaine and heroin.
During 2011-2017, the percentage of surveyed opioid users seeking treatment who reported also using methamphetamine over the past month skyrocketed from 19% to 34%, researchers reported at the 2018 annual meeting of the College on Problems of Drug Dependence.
Use of crystal meth specifically went up by 82% and the use of prescription stimulants rose by 15%. By contrast, use of marijuana went up by just 6%, while the use of muscle relaxants and prescription sleep drugs fell by more than half.
The findings matter, because the use of multiple illicit drugs is even more dangerous than one alone, said study coauthor and doctoral candidate Matthew S. Ellis, of Washington University in St. Louis, in an interview. “Illicit opioids carry their own serious risks such as unknown purity, not knowing if heroin is laced with fentanyl, or inexperience of users who are used to clearly marked prescription pills. Add in a secondary drug, also often used in non-oral ways, and your risk for overdose is going to significantly increase.”
The rising use of methamphetamine, which comes in such forms as crystal meth, has been overshadowed by news about the opioid epidemic. Still, as a 2018 Lancet report put it, “while the opioid crisis has exploded, the lull in the methamphetamine epidemic has quietly and swiftly reversed course, now accounting for 11% of the total number of overdose deaths.”
In regard to co-use of opioids and methamphetamines, the report said, “in states including Wisconsin and Oregon, new patterns suggest they are beginning to overlap as increasing numbers of people use both drugs” (Lancet. 2018 Feb. 24;391[10122]:713).
Meanwhile, the New York Times published a story in February 2018 headlined “Meth, the forgotten killer, is back. And it’s everywhere.” It noted that meth overdose deaths in Oregon outpace those from opioids and added: “At the United States border, agents are seizing 10-20 times the amounts they did a decade ago. Methamphetamine, experts say, has never been purer, cheaper, or more lethal.”
Overall, there’s little known about co-use of opioids and methamphetamines, said study lead author Mr. Ellis. “The reason for this is that opioid use patterns and populations of users have drastically changed in the past 20 years, and continue to do so,” he said. “Methamphetamine is becoming increasingly available at the same time that heroin and illicit fentanyl are as well. Reports suggest that the United States has shifted from a market of home-grown methamphetamine to that manufactured and sent from other countries, creating a broader market than previously seen.”
For the new study, Mr. Ellis and his colleagues examined statistics from a U.S. surveillance program of opioid users entering substance abuse programs. They focused on 13,521 participants in 47 states during 2011-2017.
Of 12 drug classes examined, only co-use of methamphetamine rose significantly over the 6-year period, Mr. Ellis said.
Among demographic and geographic groups, the researchers saw the largest increases in co-use of the two drugs in the West, Northeast, and Midwest regions, in rural and suburban areas, among groups aged 18-44 years, and among whites.
Why is co-use among opioid users increasing? “We have begun to do some qualitative work with a number of participants suggesting they use opioids and methamphetamine to balance each other out,” Mr. Ellis said. “So an addict can use opioids, but if they need to go to work, they can reinvigorate themselves with methamphetamine.”
Mr. Ellis said “this is not necessarily a new trend,” noting that the co-use of the drugs is akin to the “speedball” – a mixture of cocaine and heroin designed to blend their opposite modes of action.
However, Mr. Ellis said, “ The increases in production and spread of illicit opioids and methamphetamine into an existing market of those previously using prescription opioids was a perfect storm for these two drugs to be a problem, both separately and together.”
He said researchers also are finding that “if methamphetamine is the only thing an opioid addict can find, they will use it to stave off withdrawals as well.”
Indeed, National Public Radio reported in June 2018 that “as opioids are becoming harder to obtain, more and more users are turning to cheap methamphetamine” in Ohio’s tiny Vinton County, near Columbus.
Moving forward, Mr. Ellis said, “we cannot treat substance use in a silo of a single drug. If we attempt to treat opioid abusers by simply treating their opioid abuse – and not other drugs – then we have less of a chance of success. More of a focus needs to be put on the fact that the vast majority of opioid abusers are polysubstance users.”
The study is funded by the RADARS (Researched Abuse, Diversion and Addiction-Related Surveillance) System, an independent, nonprofit postmarketing surveillance system supported by subscription fees from pharmaceutical manufacturers that use RADARS data to track medication use and meet regulatory obligations. The study authors report no relevant disclosures.
REPORTING FROM CPDD 2018
Key clinical point: The percentage of opioid users who also use methamphetamine is on the rise.
Major finding: During 2011-2017, the percentage of opioid users reporting methamphetamine use over the past month grew from 19% to 34%.
Study details: Analysis of 2011-2017 data from 13,521 opioid-using participants entering substance abuse programs.
Disclosures: The study is funded by the RADARS System, an independent, nonprofit postmarketing surveillance system supported by subscription fees from pharmaceutical manufacturers that use RADARS data to track medication use and meet regulatory obligations. The study authors report no relevant disclosures.
Antidrug vaccines: A shot in the arm against addiction?
SAN DIEGO – Heroin, methamphetamine, and cocaine might not seem to have much in common with germs, but chemist Kim D. Janda, PhD, and his colleagues are trying to trick the human body into looking at them the same way: As invaders who must be conquered.
And what’s the best way to prepare the immune system for a fight? Train it through vaccination – the key to so many victories over viruses and bacteria.
For decades now, Dr. Janda, of the Scripps Research Institute in La Jolla, Calif., and other scientists have tried to develop a vaccine that would blunt the effects of substances of abuse, such as illicit drugs and even tobacco. The idea is to arm the immune system with antibodies that will prevent some or all drug components from breaking through the blood-brain barrier and producing psychoactive reactions.
In a follow-up interview after his presentation at the annual meeting of the College on Problems of Drug Dependence, Dr. Janda spoke about the history of research in this area, the potential workings of a vaccine, and the challenges of moving his own research forward.
Question: What’s the history of scientists’ efforts to develop a vaccine against drugs of abuse?
Answer: People looked at it back in the 1970s, but it didn’t really pan out. It was pretty dormant until we published research about a cocaine vaccine in 1995.
We worked on that for a while, then we looked at methamphetamine, Rohypnol, and opioids. There have been clinical trials for nicotine and cocaine, but they’ve failed.
Q: How are these vaccines expected to work?
A: The idea of the vaccines is that you don’t get high, so you won’t feel the effect of the drugs. They’ll never reach the pleasure centers that they’re supposed to.
Q: Is the idea that everyone would get a vaccine against, say, cocaine or heroin, like we routinely get vaccines against various diseases?
A: For an infectious disease like measles or mumps, you give vaccinations, and herd immunity develops. That’s not the case here. These work in a different manner, and they’re not going to be useful for people who don’t want to get off the drug. Instead, they’re going to be useful for people who want to obtain sobriety. If someone has a weak moment and tries to take the drug to get high, this would hopefully stop that from happening. It could also help overdoses in some cases, since you’re not getting that much drug into the central nervous system where it can cause cardiac arrest.
Q: How often would people be vaccinated?
A: These are vaccines that will be on board for a certain amount of time. We envision 3-4 shots over a 3-month period. You’d come back once a month for 3 months, and you’d be good for maybe 4-6 months.
Q: Where does your research stand now?
A: We’ve made a lot of advances with the opioids, and they’re good enough to put a vaccine in the clinic. Money is the issue. It’s always the issue. But we have to get up to the plate and take our swings – and find if we’ll strike out or get a hit.
SAN DIEGO – Heroin, methamphetamine, and cocaine might not seem to have much in common with germs, but chemist Kim D. Janda, PhD, and his colleagues are trying to trick the human body into looking at them the same way: As invaders who must be conquered.
And what’s the best way to prepare the immune system for a fight? Train it through vaccination – the key to so many victories over viruses and bacteria.
For decades now, Dr. Janda, of the Scripps Research Institute in La Jolla, Calif., and other scientists have tried to develop a vaccine that would blunt the effects of substances of abuse, such as illicit drugs and even tobacco. The idea is to arm the immune system with antibodies that will prevent some or all drug components from breaking through the blood-brain barrier and producing psychoactive reactions.
In a follow-up interview after his presentation at the annual meeting of the College on Problems of Drug Dependence, Dr. Janda spoke about the history of research in this area, the potential workings of a vaccine, and the challenges of moving his own research forward.
Question: What’s the history of scientists’ efforts to develop a vaccine against drugs of abuse?
Answer: People looked at it back in the 1970s, but it didn’t really pan out. It was pretty dormant until we published research about a cocaine vaccine in 1995.
We worked on that for a while, then we looked at methamphetamine, Rohypnol, and opioids. There have been clinical trials for nicotine and cocaine, but they’ve failed.
Q: How are these vaccines expected to work?
A: The idea of the vaccines is that you don’t get high, so you won’t feel the effect of the drugs. They’ll never reach the pleasure centers that they’re supposed to.
Q: Is the idea that everyone would get a vaccine against, say, cocaine or heroin, like we routinely get vaccines against various diseases?
A: For an infectious disease like measles or mumps, you give vaccinations, and herd immunity develops. That’s not the case here. These work in a different manner, and they’re not going to be useful for people who don’t want to get off the drug. Instead, they’re going to be useful for people who want to obtain sobriety. If someone has a weak moment and tries to take the drug to get high, this would hopefully stop that from happening. It could also help overdoses in some cases, since you’re not getting that much drug into the central nervous system where it can cause cardiac arrest.
Q: How often would people be vaccinated?
A: These are vaccines that will be on board for a certain amount of time. We envision 3-4 shots over a 3-month period. You’d come back once a month for 3 months, and you’d be good for maybe 4-6 months.
Q: Where does your research stand now?
A: We’ve made a lot of advances with the opioids, and they’re good enough to put a vaccine in the clinic. Money is the issue. It’s always the issue. But we have to get up to the plate and take our swings – and find if we’ll strike out or get a hit.
SAN DIEGO – Heroin, methamphetamine, and cocaine might not seem to have much in common with germs, but chemist Kim D. Janda, PhD, and his colleagues are trying to trick the human body into looking at them the same way: As invaders who must be conquered.
And what’s the best way to prepare the immune system for a fight? Train it through vaccination – the key to so many victories over viruses and bacteria.
For decades now, Dr. Janda, of the Scripps Research Institute in La Jolla, Calif., and other scientists have tried to develop a vaccine that would blunt the effects of substances of abuse, such as illicit drugs and even tobacco. The idea is to arm the immune system with antibodies that will prevent some or all drug components from breaking through the blood-brain barrier and producing psychoactive reactions.
In a follow-up interview after his presentation at the annual meeting of the College on Problems of Drug Dependence, Dr. Janda spoke about the history of research in this area, the potential workings of a vaccine, and the challenges of moving his own research forward.
Question: What’s the history of scientists’ efforts to develop a vaccine against drugs of abuse?
Answer: People looked at it back in the 1970s, but it didn’t really pan out. It was pretty dormant until we published research about a cocaine vaccine in 1995.
We worked on that for a while, then we looked at methamphetamine, Rohypnol, and opioids. There have been clinical trials for nicotine and cocaine, but they’ve failed.
Q: How are these vaccines expected to work?
A: The idea of the vaccines is that you don’t get high, so you won’t feel the effect of the drugs. They’ll never reach the pleasure centers that they’re supposed to.
Q: Is the idea that everyone would get a vaccine against, say, cocaine or heroin, like we routinely get vaccines against various diseases?
A: For an infectious disease like measles or mumps, you give vaccinations, and herd immunity develops. That’s not the case here. These work in a different manner, and they’re not going to be useful for people who don’t want to get off the drug. Instead, they’re going to be useful for people who want to obtain sobriety. If someone has a weak moment and tries to take the drug to get high, this would hopefully stop that from happening. It could also help overdoses in some cases, since you’re not getting that much drug into the central nervous system where it can cause cardiac arrest.
Q: How often would people be vaccinated?
A: These are vaccines that will be on board for a certain amount of time. We envision 3-4 shots over a 3-month period. You’d come back once a month for 3 months, and you’d be good for maybe 4-6 months.
Q: Where does your research stand now?
A: We’ve made a lot of advances with the opioids, and they’re good enough to put a vaccine in the clinic. Money is the issue. It’s always the issue. But we have to get up to the plate and take our swings – and find if we’ll strike out or get a hit.
REPORTING FROM CPDD 2018
Think local when assessing adolescent heroin use
SAN DIEGO – Between 1999 and 2015, heroin use increased among high school students who live in Milwaukee, Chicago, and New York – trends that accompanied a rise in injection drug use in those cities.
“This implies that a subset of these students who are using heroin are probably injecting heroin as well; otherwise these trends wouldn’t be mirroring each other so well,” lead study author Sherri-Chanelle Brighthaupt said in an interview at the annual meeting of the College on Problems of Drug Dependence.
The finding comes from a trend analysis of heroin use and injection drug use in nine urban U.S. school districts drawn from Youth Risk Behavior Survey (YRBS) data from 1999-2015. The analysis was conducted using data from New York City, three Florida counties (Broward, Orange, and Miami-Dade), Dallas, Chicago, Milwaukee, and two California cities (San Diego and San Bernardino). a third-year doctoral student in the department of mental health at Johns Hopkins University, Baltimore. “National estimates may mask variation at the local level.”
The sample population studied included local-level YRBS responses from 260,952 students in grades 9-12. All responses were weighted by sex, grade, and race/ethnicity, and the researchers used logistic regression models to test for liner and quadratic trends in the pooled sample and in each city. Between 1999 and 2015, lifetime heroin use among this population increased significantly, from 2.8% to 7.4% in Milwaukee (P = .0001), from 3.1% to 4.1% in Chicago (P = .02), and from 1% to 2.5% in New York (P less than .0001). However, during the same time frame, heroin use decreased in San Bernardino from 4.6% to 1.6% (P = .0001).
The researchers also found that between 1999 and 2015, lifetime injection drug use in this age group increased significantly, from 0.8% to 2.2% in New York (P less than .0001) and from 2.5% to 2.7% in Chicago (P = .05). During the same time period, lifetime injection drug use decreased in San Bernardino, (from 2.5% to 1.9%; P = .05) and in Dallas after peaking in 2007 (from 3.6% to 1%; P = .02).
“The take-home message is to look locally,” Ms. Brighthaupt said. “Some cities may have a historically entrenched culture of heroin use, and prevention and intervention efforts should be tailored to the unique social and cultural context of the geographic region.”
The research was supported by grants from the National Institute on Drug Abuse. Ms. Brighthaupt reported having no financial disclosures.
SAN DIEGO – Between 1999 and 2015, heroin use increased among high school students who live in Milwaukee, Chicago, and New York – trends that accompanied a rise in injection drug use in those cities.
“This implies that a subset of these students who are using heroin are probably injecting heroin as well; otherwise these trends wouldn’t be mirroring each other so well,” lead study author Sherri-Chanelle Brighthaupt said in an interview at the annual meeting of the College on Problems of Drug Dependence.
The finding comes from a trend analysis of heroin use and injection drug use in nine urban U.S. school districts drawn from Youth Risk Behavior Survey (YRBS) data from 1999-2015. The analysis was conducted using data from New York City, three Florida counties (Broward, Orange, and Miami-Dade), Dallas, Chicago, Milwaukee, and two California cities (San Diego and San Bernardino). a third-year doctoral student in the department of mental health at Johns Hopkins University, Baltimore. “National estimates may mask variation at the local level.”
The sample population studied included local-level YRBS responses from 260,952 students in grades 9-12. All responses were weighted by sex, grade, and race/ethnicity, and the researchers used logistic regression models to test for liner and quadratic trends in the pooled sample and in each city. Between 1999 and 2015, lifetime heroin use among this population increased significantly, from 2.8% to 7.4% in Milwaukee (P = .0001), from 3.1% to 4.1% in Chicago (P = .02), and from 1% to 2.5% in New York (P less than .0001). However, during the same time frame, heroin use decreased in San Bernardino from 4.6% to 1.6% (P = .0001).
The researchers also found that between 1999 and 2015, lifetime injection drug use in this age group increased significantly, from 0.8% to 2.2% in New York (P less than .0001) and from 2.5% to 2.7% in Chicago (P = .05). During the same time period, lifetime injection drug use decreased in San Bernardino, (from 2.5% to 1.9%; P = .05) and in Dallas after peaking in 2007 (from 3.6% to 1%; P = .02).
“The take-home message is to look locally,” Ms. Brighthaupt said. “Some cities may have a historically entrenched culture of heroin use, and prevention and intervention efforts should be tailored to the unique social and cultural context of the geographic region.”
The research was supported by grants from the National Institute on Drug Abuse. Ms. Brighthaupt reported having no financial disclosures.
SAN DIEGO – Between 1999 and 2015, heroin use increased among high school students who live in Milwaukee, Chicago, and New York – trends that accompanied a rise in injection drug use in those cities.
“This implies that a subset of these students who are using heroin are probably injecting heroin as well; otherwise these trends wouldn’t be mirroring each other so well,” lead study author Sherri-Chanelle Brighthaupt said in an interview at the annual meeting of the College on Problems of Drug Dependence.
The finding comes from a trend analysis of heroin use and injection drug use in nine urban U.S. school districts drawn from Youth Risk Behavior Survey (YRBS) data from 1999-2015. The analysis was conducted using data from New York City, three Florida counties (Broward, Orange, and Miami-Dade), Dallas, Chicago, Milwaukee, and two California cities (San Diego and San Bernardino). a third-year doctoral student in the department of mental health at Johns Hopkins University, Baltimore. “National estimates may mask variation at the local level.”
The sample population studied included local-level YRBS responses from 260,952 students in grades 9-12. All responses were weighted by sex, grade, and race/ethnicity, and the researchers used logistic regression models to test for liner and quadratic trends in the pooled sample and in each city. Between 1999 and 2015, lifetime heroin use among this population increased significantly, from 2.8% to 7.4% in Milwaukee (P = .0001), from 3.1% to 4.1% in Chicago (P = .02), and from 1% to 2.5% in New York (P less than .0001). However, during the same time frame, heroin use decreased in San Bernardino from 4.6% to 1.6% (P = .0001).
The researchers also found that between 1999 and 2015, lifetime injection drug use in this age group increased significantly, from 0.8% to 2.2% in New York (P less than .0001) and from 2.5% to 2.7% in Chicago (P = .05). During the same time period, lifetime injection drug use decreased in San Bernardino, (from 2.5% to 1.9%; P = .05) and in Dallas after peaking in 2007 (from 3.6% to 1%; P = .02).
“The take-home message is to look locally,” Ms. Brighthaupt said. “Some cities may have a historically entrenched culture of heroin use, and prevention and intervention efforts should be tailored to the unique social and cultural context of the geographic region.”
The research was supported by grants from the National Institute on Drug Abuse. Ms. Brighthaupt reported having no financial disclosures.
AT CPDD 2018
Key clinical point: Trends in heroin use and injection drug use follow one another over time.
Major finding: Between 1999 and 2015, lifetime heroin use increased significantly, from 2.8% to 7.4% in Milwaukee (P = .0001), from 3.1% to 4.1% in Chicago (P = .02), and from 1% to 2.5% in New York (P less than .0001).
Study details: An analysis of local-level Youth Risk Behavior Survey responses from 260,952 students in grades 9-12.
Disclosures: The research was supported by grants from the National Institute on Drug Abuse. Ms. Brighthaupt reported having no financial disclosures.
Many veterans with comorbid pain and OUD not receiving MAT
SAN DIEGO – Less than 30% of veterans on medication-assisted treatment for opioids had a diagnosis of opioid use disorder, and only 7% of veterans with an opioid use disorder initiated medication-assisted treatment.
Those are key findings from a large study that set out to assess factors associated with initiating medication-assisted treatment (MAT) among veterans seeking pain care and to characterize the cohort of veterans seeking specialty pain care who initiated MAT.
“ but it was really low,” lead study author Lisham Ashrafioun, PhD, said in an interview at the annual meeting of the College on Problems of Drug Dependence. “These findings are preliminary, but I think we need to understand a lot more about how to treat people with opioid use disorders who are receiving pain care as well.”
Dr. Ashrafioun, a research investigator at the Veteran Affairs Center of Excellence for Suicide Prevention at the Canandaigua VA Medical Center, N.Y., and his associates drew from national VA electronic medical record data to identify 219,443 veterans who initiated specialty pain services during fiscal year 2012-2014. They used procedure and billing codes to identify veterans who started using MAT for opioids within the year following initiation of pain services, and extracted data on demographics, psychiatric and medical diagnoses, and pain intensity scores.
Of the 219,443 veterans, only 2,406 had received MAT in the year following the index visit (1.1%). In addition, only 26.4% of those on MAT had an opioid use disorder and just 6.6% of those with an opioid use disorder initiated MAT.
In adjusted analyses, opioid use disorders (adjusted odds ratio, 5.71) and opioid prescriptions (aOR, 2.33) were significantly associated with greater odds of receiving MAT. Moreover, having a diagnosis of depression was associated with a greater odds of receiving MAT (aOR, 1.26), while having a diagnosis of PTSD was associated with a greater odds of not receiving it (aOR, 0.90). The researchers also found that having a diagnosis of alcohol use disorder was associated with a greater odds of not receiving MAT (aOR, 0.85), while having a diagnosis of drug use disorder was associated with a greater odds of receiving it (aOR, 1.32).
Dr. Ashrafioun, who also holds a faculty position in the department of psychiatry at the University of Rochester (N.Y.), acknowledged certain limitations of the study. For example, the sample was restricted to only those receiving specialty pain care, provider and facility variation was not accounted for, and study participants might have initiated MAT outside of the VA.
He reported having no financial disclosures.
[email protected]
SAN DIEGO – Less than 30% of veterans on medication-assisted treatment for opioids had a diagnosis of opioid use disorder, and only 7% of veterans with an opioid use disorder initiated medication-assisted treatment.
Those are key findings from a large study that set out to assess factors associated with initiating medication-assisted treatment (MAT) among veterans seeking pain care and to characterize the cohort of veterans seeking specialty pain care who initiated MAT.
“ but it was really low,” lead study author Lisham Ashrafioun, PhD, said in an interview at the annual meeting of the College on Problems of Drug Dependence. “These findings are preliminary, but I think we need to understand a lot more about how to treat people with opioid use disorders who are receiving pain care as well.”
Dr. Ashrafioun, a research investigator at the Veteran Affairs Center of Excellence for Suicide Prevention at the Canandaigua VA Medical Center, N.Y., and his associates drew from national VA electronic medical record data to identify 219,443 veterans who initiated specialty pain services during fiscal year 2012-2014. They used procedure and billing codes to identify veterans who started using MAT for opioids within the year following initiation of pain services, and extracted data on demographics, psychiatric and medical diagnoses, and pain intensity scores.
Of the 219,443 veterans, only 2,406 had received MAT in the year following the index visit (1.1%). In addition, only 26.4% of those on MAT had an opioid use disorder and just 6.6% of those with an opioid use disorder initiated MAT.
In adjusted analyses, opioid use disorders (adjusted odds ratio, 5.71) and opioid prescriptions (aOR, 2.33) were significantly associated with greater odds of receiving MAT. Moreover, having a diagnosis of depression was associated with a greater odds of receiving MAT (aOR, 1.26), while having a diagnosis of PTSD was associated with a greater odds of not receiving it (aOR, 0.90). The researchers also found that having a diagnosis of alcohol use disorder was associated with a greater odds of not receiving MAT (aOR, 0.85), while having a diagnosis of drug use disorder was associated with a greater odds of receiving it (aOR, 1.32).
Dr. Ashrafioun, who also holds a faculty position in the department of psychiatry at the University of Rochester (N.Y.), acknowledged certain limitations of the study. For example, the sample was restricted to only those receiving specialty pain care, provider and facility variation was not accounted for, and study participants might have initiated MAT outside of the VA.
He reported having no financial disclosures.
[email protected]
SAN DIEGO – Less than 30% of veterans on medication-assisted treatment for opioids had a diagnosis of opioid use disorder, and only 7% of veterans with an opioid use disorder initiated medication-assisted treatment.
Those are key findings from a large study that set out to assess factors associated with initiating medication-assisted treatment (MAT) among veterans seeking pain care and to characterize the cohort of veterans seeking specialty pain care who initiated MAT.
“ but it was really low,” lead study author Lisham Ashrafioun, PhD, said in an interview at the annual meeting of the College on Problems of Drug Dependence. “These findings are preliminary, but I think we need to understand a lot more about how to treat people with opioid use disorders who are receiving pain care as well.”
Dr. Ashrafioun, a research investigator at the Veteran Affairs Center of Excellence for Suicide Prevention at the Canandaigua VA Medical Center, N.Y., and his associates drew from national VA electronic medical record data to identify 219,443 veterans who initiated specialty pain services during fiscal year 2012-2014. They used procedure and billing codes to identify veterans who started using MAT for opioids within the year following initiation of pain services, and extracted data on demographics, psychiatric and medical diagnoses, and pain intensity scores.
Of the 219,443 veterans, only 2,406 had received MAT in the year following the index visit (1.1%). In addition, only 26.4% of those on MAT had an opioid use disorder and just 6.6% of those with an opioid use disorder initiated MAT.
In adjusted analyses, opioid use disorders (adjusted odds ratio, 5.71) and opioid prescriptions (aOR, 2.33) were significantly associated with greater odds of receiving MAT. Moreover, having a diagnosis of depression was associated with a greater odds of receiving MAT (aOR, 1.26), while having a diagnosis of PTSD was associated with a greater odds of not receiving it (aOR, 0.90). The researchers also found that having a diagnosis of alcohol use disorder was associated with a greater odds of not receiving MAT (aOR, 0.85), while having a diagnosis of drug use disorder was associated with a greater odds of receiving it (aOR, 1.32).
Dr. Ashrafioun, who also holds a faculty position in the department of psychiatry at the University of Rochester (N.Y.), acknowledged certain limitations of the study. For example, the sample was restricted to only those receiving specialty pain care, provider and facility variation was not accounted for, and study participants might have initiated MAT outside of the VA.
He reported having no financial disclosures.
[email protected]
REPORTING FROM CPDD 2018
Key clinical point: Several clinical features differentiate veterans seeking specialty pain care who receive medication-assisted treatment (MAT) from those who do not.
Major finding: Only 26.5% of veterans on MAT had an opioid use disorder.
Study details: An analysis of 219,443 veterans who initiated specialty pain services during fiscal year 2012-2014.
Disclosures: Dr. Ashrafioun reported having no financial disclosures.
Cocaine use declining among young adults
SAN DIEGO – Use of cocaine by young adults in the United States has declined significantly since the early 2000s, but it remains relatively common. In fact, results from an analysis of national data suggest that about 5% of 18- to 22-year-olds have used cocaine in the past 12 months.
“We don’t typically think of cocaine use amongst young people, but it is of a nontrivial prevalence,” lead study author Kristin E. Schneider said in an interview at the annual meeting of the College on Problems of Drug Dependence. “If someone has risky alcohol use they might also have risky substance use. We need to be screening for those things as well, while most interventions these days focus on problem drinking.”
Ms. Schneider, a graduate student in the department of mental health at Johns Hopkins University, Baltimore, and her associates drew from the 2002-2014 waves of the National Survey on Drug Use and Health to describe trends in cocaine use among young adults by race/ethnicity, sex, and college enrollment. They assessed for lifetime use, any past 12-month cocaine use, past 30-day use, and any past 12-month use disorder. They also tested for linear and quadratic trends over time.
When the researchers averaged across all years, they found that 12.1% of young adults had ever used cocaine, 5.9% had used it in the past 12 months, 1.8% had used in the past 30 days, and 1% had a use disorder in the past 12 months. They also observed significant linear declines in cocaine use across the entire study period. For example, between 2002 and 2014, the prevalence of lifetime cocaine use declined from 13.7% to 8.6%, past 12-month use declined from 6.3% to 4.1%, and past 30-day use declined from 1.8% to 1.4%.
Nonstudents had higher lifetime rates of cocaine use, compared with students (14.8% vs. 7.8%, respectively), but differences between the two groups were small for other indicators. “Perhaps being an emerging environment with other [young] adults who are also making risky health behavior decisions compensates for this baseline difference of risk between people who go to college and those who do not,” Ms. Schneider said. At the same time, the lowest rates of past 12-month cocaine use was observed in black males (1.6%), Asian females (0.8%), and black females (0.8%).
The National Institute on Drug Abuse supported the study. Ms. Schneider reported having no financial disclosures.
SAN DIEGO – Use of cocaine by young adults in the United States has declined significantly since the early 2000s, but it remains relatively common. In fact, results from an analysis of national data suggest that about 5% of 18- to 22-year-olds have used cocaine in the past 12 months.
“We don’t typically think of cocaine use amongst young people, but it is of a nontrivial prevalence,” lead study author Kristin E. Schneider said in an interview at the annual meeting of the College on Problems of Drug Dependence. “If someone has risky alcohol use they might also have risky substance use. We need to be screening for those things as well, while most interventions these days focus on problem drinking.”
Ms. Schneider, a graduate student in the department of mental health at Johns Hopkins University, Baltimore, and her associates drew from the 2002-2014 waves of the National Survey on Drug Use and Health to describe trends in cocaine use among young adults by race/ethnicity, sex, and college enrollment. They assessed for lifetime use, any past 12-month cocaine use, past 30-day use, and any past 12-month use disorder. They also tested for linear and quadratic trends over time.
When the researchers averaged across all years, they found that 12.1% of young adults had ever used cocaine, 5.9% had used it in the past 12 months, 1.8% had used in the past 30 days, and 1% had a use disorder in the past 12 months. They also observed significant linear declines in cocaine use across the entire study period. For example, between 2002 and 2014, the prevalence of lifetime cocaine use declined from 13.7% to 8.6%, past 12-month use declined from 6.3% to 4.1%, and past 30-day use declined from 1.8% to 1.4%.
Nonstudents had higher lifetime rates of cocaine use, compared with students (14.8% vs. 7.8%, respectively), but differences between the two groups were small for other indicators. “Perhaps being an emerging environment with other [young] adults who are also making risky health behavior decisions compensates for this baseline difference of risk between people who go to college and those who do not,” Ms. Schneider said. At the same time, the lowest rates of past 12-month cocaine use was observed in black males (1.6%), Asian females (0.8%), and black females (0.8%).
The National Institute on Drug Abuse supported the study. Ms. Schneider reported having no financial disclosures.
SAN DIEGO – Use of cocaine by young adults in the United States has declined significantly since the early 2000s, but it remains relatively common. In fact, results from an analysis of national data suggest that about 5% of 18- to 22-year-olds have used cocaine in the past 12 months.
“We don’t typically think of cocaine use amongst young people, but it is of a nontrivial prevalence,” lead study author Kristin E. Schneider said in an interview at the annual meeting of the College on Problems of Drug Dependence. “If someone has risky alcohol use they might also have risky substance use. We need to be screening for those things as well, while most interventions these days focus on problem drinking.”
Ms. Schneider, a graduate student in the department of mental health at Johns Hopkins University, Baltimore, and her associates drew from the 2002-2014 waves of the National Survey on Drug Use and Health to describe trends in cocaine use among young adults by race/ethnicity, sex, and college enrollment. They assessed for lifetime use, any past 12-month cocaine use, past 30-day use, and any past 12-month use disorder. They also tested for linear and quadratic trends over time.
When the researchers averaged across all years, they found that 12.1% of young adults had ever used cocaine, 5.9% had used it in the past 12 months, 1.8% had used in the past 30 days, and 1% had a use disorder in the past 12 months. They also observed significant linear declines in cocaine use across the entire study period. For example, between 2002 and 2014, the prevalence of lifetime cocaine use declined from 13.7% to 8.6%, past 12-month use declined from 6.3% to 4.1%, and past 30-day use declined from 1.8% to 1.4%.
Nonstudents had higher lifetime rates of cocaine use, compared with students (14.8% vs. 7.8%, respectively), but differences between the two groups were small for other indicators. “Perhaps being an emerging environment with other [young] adults who are also making risky health behavior decisions compensates for this baseline difference of risk between people who go to college and those who do not,” Ms. Schneider said. At the same time, the lowest rates of past 12-month cocaine use was observed in black males (1.6%), Asian females (0.8%), and black females (0.8%).
The National Institute on Drug Abuse supported the study. Ms. Schneider reported having no financial disclosures.
AT CPDD 2018
Key clinical point: Cocaine use has declined among young adults in the United States.
Major finding: Between 2002 and 2014, the prevalence of lifetime cocaine use declined from 13.7% to 8.6%.
Study details: An analysis drawn from the 2002-2014 waves of the National Survey on Drug Use and Health.
Disclosures: The National Institute on Drug Abuse supported the study. Ms. Schneider reported having no financial disclosures.